| Jackson Pediatric Dentistry Llc | |
|
1236 Ebenezer Rd Suite 110 Rock Hill SC 29732-3390 | |
| (803) 324-7540 | |
| (803) 324-4128 |
| Full Name | Jackson Pediatric Dentistry Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1236 Ebenezer Rd, Rock Hill, South Carolina |
| Authorized Official Name and Position | Stephanie Lynn Jackson (PEDIATRIC DENTIST) |
| Authorized Official Contact | 9194124199 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Pediatric Dentistry Llc 1686 Highway 160 W Fort Mill SC 29708-8024 Ph: (803) 548-2333 | Jackson Pediatric Dentistry Llc 1236 Ebenezer Rd Suite 110 Rock Hill SC 29732-3390 Ph: (803) 324-7540 |
| NPI Number | 1144679507 |
|---|---|
| Provider Enumeration Date | 06/07/2016 |
| Last Update Date | 08/03/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144679507 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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